Harm by poison
“My heart aches, and a drowsy numbness pains my sense, as though of hemlock I had drunk,” — John Keats (1795-1821), English Romantic poet, “Ode to a Nightingale” (1819)
John Keats would have known that hemlock was both a drug and a poison for he was both a surgeon and a poet. In fact, I want to think that he had Socrates in mind. Dying by hemlock was the great philosopher’s punishment for “corrupting the minds” of Athenian youth. This brings us to poisoning, ingested willfully or by accident, the effects of which are myriad.
Definition. Poisoning is de ned as “the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in contact with the skin, eyes, or mucous membranes, such as those of the mouth or nose,” (Merck Manual). This means that almost any substance taken incorrectly or in excess can become toxic. Examples are overthe-counter drugs (paracetamol, acetaminophen) or prescription drugs (benzodiazepines, heart medications, etc.), and of course illegal drugs, carbon monoxide in vehicle exhausts, household products like detergents and furniture polish, pesticides, and metals like lead and mercury.
The first rule for the first aider is NOT to get poisoned himself. The US National Institutes of Health website tells us what to do in cases of swallowed poison: For poisoning by swallowing: “Check and monitor the person’s airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. Try to make sure that the person has indeed been poisoned. It may be hard to tell. Some signs include chemical-smelling breath, burns around the mouth, difficulty breathing, vomiting, or unusual odors on the person. If possible, identify the poison. Do NOT make a person throw up unless told to do so by poisoncontrol or a health-care professional. If the person vomits, clear the person’s airway. Wrap a cloth around your ngers before cleaning out the mouth and throat. If the person has been sick from a plant part, save the vomit. It may help experts identify what medicine can be used to help reverse the poisoning. Keep the person comfortable. The person should be rolled onto the left side, and remain there while getting or waiting for medical help. If the poison has spilled on the person’s clothes, remove the clothing and ush the skin with water.”
For inhaled poisoning: “Call for emergency help. Never attempt to rescue a person without notifying others rst. If it is safe to do so, rescue the person from the danger of the gas, fumes, or smoke. Open windows and doors to remove the fumes. Take several deep breaths of fresh air, and then hold your breath as you go in. Hold a wet cloth over your nose and mouth. Do not light a match or use a lighter because some gases can catch
re. After rescuing the person from danger, check and monitor the person’s airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. If the person vomits, clear the person’s airway. Wrap a cloth around your ngers before cleaning out the mouth and throat. Even if the person seems perfectly ne, get medical help.”
I suppose that there’s something both romantic and sel sh about poisoning. It’s the stuff of tragic novels and telenovelas. But as an intern at PGH’s Admitting Section, I’ve seen and treated poisoning cases. All that foaming in the mouth and vomitus, shaking and moaning (and not in a good way), and if the sphincters relax, urine and feces all over. Not a pretty sight.
John Keats probably wanted to poison himself too in his long, losing battle with tuberculosis. He kept asking for laudanum (cinnamon
avored 10% opium, 90% alcohol) to ease the pain of his bloody coughs. Drug addiction is nothing but longdrawn poisoning. I guess we all have our own poisons.
Dr. Pujalte is an orthopedic surgeon. e-mail firstname.lastname@example.org